CONTACTS
SUBJECTS
VA Notify Injury Hematoma Left Leg Symptoms Worsening Pain Need Crut
1403 -
1403 - ..
1404 - Summary/Objective
1405 -
140501 - Follow up ref SDS 43 0000. ref SDS 40 0000.
140502 -
140503 -
140504 -
140505 - [On 160606 1409 telecon with Marilyn with Auditory and
140506 - Balance Department scheduled meeting on 160707 0900.
140507 - ref SDS 44 8Y5N
140509 - ..
140510 - [On 160611 1054 letter from Doctor Simpson proposes doing
140511 - Zio rather than Holter monitor cardiology test to review
140512 - balance issue. ref SDS 45 QY5F
140513 -
140514 -
140515 -
140517 - ..
1406 -
1407 -
1408 - Background
1409 -
140901 - On 160504, met Lauren Rettberg, NP PA, in Primary Care. Reported loss
140902 - of balance that caused fall on 160501, ref SDS 31 JN3J, shown in case
140903 - study on 140101 0600. ref SDS 7 O85F Lauren performed a neurological
140904 - test, passed this including Romberg's balance test. ref SDS 31 WZ50
140906 - ..
140907 - On 160513 Lauren called and discussed referral to Wound Care for
140908 - treatment of new injury to left leg Achilles' tendon. ref SDS 34 FG5O
140909 - Lauren also planned to consult with Neurology about balance problem,
140910 - ref SDS 34 YK6J; she may make referral to Physical Therapy to evaluate
140911 - and assist with recovery balance problem. ref SDS 34 YK68 Lauren will
140912 - schedule visit for performing care to recover from calcified crystals
140913 - breaking loose from vestibular chamber and falling into semicircular
140914 - canals that cause loss of balance. ref SDS 34 YK72
140916 - ..
140917 - On 160523 visited Rose (Marie) in Medical Practice, scheduled call
140918 - from Lauren for Primary Care support on 160525 1130. ref SDS 36 PG6N
140919 - Rose on the Appointment care 5/23, so called back and got correction
140920 - from Bridget. ref SDS 36 8M9M
140922 - ..
140923 - On 160523 0830 meeting with Mike in Physical Therapy, ref SDS 37 010U,
140924 - reviewed 4 falls past few years, ref SDS 37 EL7G; Mike performed
140925 - Dix-Hallpike head movement maneuver testing for BPPV, (Benign
140926 - paroxysmal positional vertigo), ref SDS 37 R657, explained in the
140927 - record on 160513 1100. ref SDS 34 4W62 Seemed to pass Romberg's test,
140928 - and heel-toe test. ref SDS 37 EQ9O Failed test in machine with feet
140929 - support moving and walls rotating. ref SDS 37 IZ6F Mike diagnosed
140930 - falls that seem unrelated to dizziness and with no awarness of falling
140931 - as "Vestibular Hypofunction." ref SDS 37 X89J
140933 - ..
140934 - On 160525 1130 Lauren called - she scheduled meeting on 160603 1030,
140935 - to maneuver head for resolving balance problem by dislodging calcified
140936 - crystals from semicircle balance canals near the hears. ref SDS 40 SY6N
140937 - Maneta called later and changed this to 1100. ref SDS 40 GT5G Lauren
140938 - also contacted Neurology and advised they want to meet with patient
140939 - immediately. She asked if a meeting has been scheduled. Since this
140940 - has not happened, she will call them again. She said that if
140941 - Neurology has not scheduled a meeting by this Friday, on 160527, to
140942 - call and request a meeting.
140943 -
140944 -
140946 - ..
1410 -
1411 -
1412 - Progress
1413 -
141301 - Meeting Doctor Yoo in Neurology Resolve BPPV Balance Dizziness Problems
141302 -
141303 - Follow up ref SDS 43 QY5F, ref SDS 40 4X4H.
141304 -
141305 - On 160601 1429 received call from Lauren confirming meeting with her
141306 - on 160601 1100, ref SDS 43 QY5F, and further notifying meeting
141307 - scheduled with Neurology on 160603 1430. ref SDS 42 Q66I
141309 - ..
141310 - Today, met with Doctor Alex Yoo.
141312 - ..
141313 - He reviewed the record of Physical Therapy on 160523, 160523 0830,
141314 - ref SDS 37 010U, citing 4 falls in the past year, ref SDS 37 EL7G, and
141315 - including Mike's findings performing the Dix-Hallpike maneuver that
141316 - identified dizziness on the left vestibular chamber. ref SDS 37 R657
141318 - ..
141319 - Alex indicated this condition does not seem to have been a factor in
141320 - the fall hiking Half Dome on 150916, nor the recent fall in Crystal
141321 - Rock Park on 160501.
141323 - ..
141324 - Alex performed a battery of tests, including...
141325 -
141326 - 1. Romberg's test standing with feet together and eyes shut
141327 - for 30 seconds or so.
141328 -
141329 - 2. Heel-toe steps - walked all the way to the end of the hall
141330 - without a misstep.
141332 - ..
141333 - 3. Visual - peripheral vision
141334 -
141335 - 1. Eye movement following Alex's finger as he moved it
141336 - various directions.
141337 -
141338 - 2. Recognize number of fingers displayed by Alex at
141339 - various distances and postions.
141341 - ..
141342 - 4. Voice and memory...
141343 -
141344 - 1. Repeat a sequence of words he spoke.
141345 -
141346 - 2. Repeat a sequence of numbers he spoke.
141348 - ..
141349 - 5. Tactile sensitivity
141351 - ..
141352 - 6. Auditory sensitivity
141354 - ..
141355 - 7. Hand eye coordination...
141356 -
141357 - 1. touch his finger about 18" away, then touch the nose
141358 - with both hands.
141359 -
141360 - 2. Touch opposite ear with 2 fingers.
141361 -
141363 - ..
141364 - Alex indicated there are no evident neurological causes for the 2
141365 - falls. The best explanation is that fatigue caused fall on Half Dome,
141366 - and similarly falling at Castle Rock Park on 160501.
141368 - ..
141369 - Alex is familiar with the Mist Trail in Yosemite Valley that leads to
141370 - Vernal Falls, and then joins with John Muir trail to Nevada Falls, and
141371 - onto the top of Half Dome. Alex has not done Half Dome, but is aware
141372 - that the hike to Vernal Falls is rigorous. He feels the record
141373 - showing the patient ascended the Mist Trail to Vernal Falls on 150916
141374 - about 10 minutes faster than the 2 prior years, and in particular 2
141375 - years earlier on 130918, when the patient reached the top of Half
141376 - Dome, indicates more energy was expended on the initial leg of the
141377 - ascent to Vernal Falls. This likely fatigued the body enough to cause
141378 - the fall on 150916, hiking from Vernal Falls up to Vernal Falls, and
141379 - which ultimately required treatment at the VA.
141381 - ..
141382 - Similarly, the fall on 160501, occurred traversing complex terrain
141383 - stepping on stones/bolders at variable distances. The 11 mile hike
141384 - earlier in the day fatigued the body enough for this level of physical
141385 - exertion and mental concentration to fall short of what was required,
141386 - thus causing a fall.
141388 - ..
141389 - The remedy for Half Dome is to do the hike slower, which means more
141390 - rest stops, so the body is at all times prepared to meet difficult
141391 - conditions. The remedy for Crystal Rock Park is to rest longer
141392 - between doing extended endurance exercise, like hiking 11 miles, and
141393 - then undertaking another long hike but with increased complications
141394 - of difficult terrain, e.g., do the 11 miles the day before.
141396 - ..
141397 - At the conclusion of the meeting, Alex explained comprehensive review
141398 - of seemingly inexplicable falls could indicate possible coronary
141399 - causes. He proposed recommending that Primary Care refer to
141400 - Cardiology for continual heart function test.
141402 - ..
141403 - Explained that Doctor Egan in Cardiology at the VA in Martinez,
141404 - ordered a Helter Monitor 24-hour test on 110310, ref SDS 2 OF8F, 18
141405 - months after CABG x4 surgery on 091022. On 110415 0900 Doctor Egan
141406 - reported Helter monitor test and stress test favorable for healthy
141407 - coronary pulmonary function. ref SDS 4 SH5L
141409 - ..
141410 - Additionally, on 110406 1230 treadmill stress test performed; initial
141411 - indications are 100% performance, with one node showing possible
141412 - slight irregularity. ref SDS 3 OF8F
141414 - ..
141415 - None-the-less, Doctor Simpson will likely approve doing recommended
141416 - coronary tests again.
141417 -
141418 - [On 160611 1054 letter from Doctor Simpson proposes doing
141419 - Zio rather than Holter monitor cardiology test to review
141420 - balance issue. ref SDS 45 QY5F
141422 - ..
141423 - Alex further proposes certain specific auditory tests that evaluate
141424 - vestbular balance function other than dizziness, that may shed light
141425 - on why the fall on Half Dome, and the fall in Crystal Rock Park did
141426 - not register awareness of falling until it was too late to make
141427 - adjustments.
141428 -
141429 - [On 160606 1409 telecon with Marilyn with Auditory and
141430 - Balance Department scheduled meeting on 160707 0900.
141431 - ref SDS 44 8Y5N
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